In some clinics of the larger hospitals it is a matter of almost daily occurrence to have patients present themselves with a history of failing health, slight exhaustion, sometimes dimness of vision, dizziness, and above all a painful spot in the region of the left nipple. In many cases, if not in the majority, there may not be leading symptoms which would lead one to believe that the patient was suffering from valvular disease of the heart. If one symptom is present in the early stage which predominates over the others, it would seem to be the pain in the region of the left nipple. In some cases this pain may be of a dull or dragging character, but as a rule it is rather sharp and more or less persistent without reference to the time of eating. In such patients the heart should at once be examined. We often
PROGNOSIS IN VALVULAR HEART DISEASE. JAMA. 1899;XXXIII(1):48–49. doi:10.1001/jama.1899.02450530054017
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